CASE HISTORY

Admitted 13.4.35 with "pain inside" of a few hour duration, and breathlessness for some years. Never had rheumatic fever, St. Vitus dance or sore throats but had growing pains. Good health till 5 months advanced in 2nd pregnancy, four years ago, when began to suffer from oedema of legs, dyspnoea on exertion and palpitation. Not confined to bed, but afterwards picked up only slowly and could only do light work, sitting down every few minutes. Two years ago, again pregnant and got worse. Could keep on feet until Jan 1935, then took to bed. Night before admission: severe pain right hypochondium made worse by deep breath; dared not move. On admission: cyanosed, fibrillating apical pulse rate 130-140. Mitral stenosis and loud diastolic murmurs. Liver greatly enlarged. 22.4.35: profuse haematuria. Subsequently febrile till death. Had been improving very well up till that day. 4.5.35: Died.

PATHOLOGY

Kidney 135mmx100mmx55mm. The specimen consists of one half of the kidney. The capsule is thickened and infiltrated with blood, and almost the whole kidney substance is infarcted and of a dirty yellow colour. A few small areas near the pelvic surface of the medulla have escaped. The pelvis of the ureter is haemorrhagic. The main right renal artery was blocked 1/2" beyond the aorta by and embolic clot (not in specimen).